The goals of the proposed project are to identify and explain race-related differences in the use of informal, formal and mixed patterns of service by impaired and disabled urban elderly. Such information is needed to respond rationally to the increasing prevalence of impaired and disabled elderly, most of whom are currently cared for in the community. The project is a continuation of the Cleveland Study of the Elderly ("GAO" Study), a panel study providing 17 years of longitudinal data on the 762 proposed subjects, 25 percent of whom are black. Research questions are: 1) What mix of formal and informal services is used by community-dwelling elderly? 2) What are the effects of health impairment and disability, demographic background, and helping network on this mix of services? 3) How do attitudes and expectations of elders and their primary caregivers about service use relate to this service mix? 4) What is the combined effect of these variables on the service mix? 5) How do changes in health, helping network, disability and attitudes affect changes in this service mix? and 6) How do the above relationships differ by race? Answers will be sought in 30 months of observation of this representative sample of urban elderly (age 70 and over) and their caregivers, contained in this 4-year study. Observations will consist of face-to-face interviews at 15 month intervals, with interim telephone checks for important changes. An in-depth ethnographic study of a subset of 50 subjects will explore ethnic and cultural attitudes that influence use of services, including concepts of family, kinship, and social and religious responsibility.